Comment: The quality of evidence is downgraded by study limitations (lack of/unclear allocation concealment in half of the studies and lack of blinding) and by imprecise results (wide confidence intervals).
A Cochrane review included 10 studies with a total of 1 215 subjects. Serum procalcitonin (PCT) evaluation has been proposed for early diagnosis and accurate staging and to guide decisions regarding patients with sepsis, severe sepsis and septic shock. No significant differences in mortality at longest follow-up, at 28 days, at ICU discharge, and at hospital discharge (table ). However, mean time receiving antimicrobial therapy in the intervention groups was 1.28 days shorter. No primary study has analysed the change in antimicrobial regimen from a broad to a narrower spectrum.
| Outcome | Relative effect (95% CI) | Risk with control - Non-PCT (standard care or CRP) | Risk with intervention - PCT (95 % CI) | No of participants (studies) Quality of evidence |
|---|---|---|---|---|
| Mortality at longest follow-up | 0.81 (0.65 to 1.01) | 261 per 1000 | 211 per 1000 (169 to 263) | 1156 (10) Low |
| Mortality at 28 days | 0.89 (0.61 to 1.31) | 250 per 1000 | 223 per 1000 (153 to 328) | 316 (4) Low |
| Mortality at ICU discharge | 1.03 (0.50 to 2.11) | 97 per 1000 | 99 per 1000 (48 to 204) | 506 (3) Low |
| Mortality at hospital discharge | 0.98 (0.75 to 1.27) | 199 per 1000 | 195 per 1000 (149 to 253) | 805 (7) Moderate |
| Time receiving antimicrobial therapy (days) - mean (SD) | - | The mean time receiving antimicrobial therapy was 8.09 days (SD 1.36) | The mean time receiving antimicrobial therapy was 1.28 days lower (1.95 lower to 0.61 lower) | 313 (4) Very low |
Date of latest search: 15 July 2015